Medicare Compliance & Reimbursement

Backlog of patients trying to bail out of Medicare Advantage plans.

Effective July 1, Part B carriers will no longer pay for J7611-J7614 for nebulized drugs albuterol and levalbuterol, according to MLN Matters article MM5645.

New way: You should now use Q4093-Q4094 when billing for inhalation solution that your practice purchases and provides for a nebulizer treatment (94640) and for pre/post spirometry (94060). Make sure to mark J7611-J7614 as non-payable in your system. Think of Q4093 as replacing J7611-J7612 and Q4094 as replacing J7613-J7614, advises Christine Martin, office manager at Fremont Pulmonary Care in Nebraska.

Important: Medicare no longer pays for compounded inhalation solutions as of July 1. So you should make sure to obtain a signed Advance Beneficiary Notice (ABN) before providing a compounded solution--one that is mixed, combined or altered for an individual. That way, the patient will be responsible for payment. In Other News... · U.S. District Court Judge Fedrico Moreno sentenced Miami physician Julian Torres to 36 months' imprisonment and $1.36 million in repayment, for his role in a fake-prescription scheme. Prosecutors said Torres received $40,000 in kickbacks for writing 800 false prescriptions for unnecessary medical equipment.